Patient Use of Secure Electronic Messaging Within a Shared Medical Record: A Cross-sectional Study

BACKGROUND  Most patients would like to be able to exchange electronic messages with personal physicians. Few patients and providers are exchanging electronic communications. OBJECTIVE  To evaluate patient characteristics associated with the use of secure electronic messaging between patients and health care providers. DESIGN, SETTING, AND PATIENTS  Cross-sectional cohort study of enrollees over 18 years of age who were enrolled in an integrated delivery system in 2005. MEASUREMENTS AND MAIN RESULTS  Among eligible enrollees, 14% (25,075) exchanged one or more secure messages with a primary or specialty care provider between January 1, 2004 and March 31, 2005. Higher secure messaging use by enrollees was associated with female gender (OR, 1.15; 95% CI, 1.10–1.19), greater overall morbidity (OR, 5.64; 95% CI, 5.07–6.28, comparing high or very high to very low overall morbidity), and the primary care provider’s use of secure messaging with other patients (OR, 1.94; 95% CI, 1.67–2.26, comparing 20–50% vs. ≤10% encounters through secure messaging). Less secure messaging use was associated with enrollee age over 65 years (OR, 0.65; CI, 0.59–0.71) and Medicaid insurance vs. commercial insurance (OR, 0.81; 95% CI, 0.68–0.96). CONCLUSIONS  In this integrated group practice, use of patient–provider secure messaging varied according to individual patient clinical and sociodemographic characteristics. Future studies should clarify variation in the use of electronic patient–provider messaging and its impact on the quality and cost of care received. Funding Sources  This study was funded by the Agency for Health Care Research and Quality (Grant No. R03 HS014625–01). Human Subjects Protections Review and Approval  This study was reviewed and approved by the Group Health Center for Health Studies Institutional Review Board.